Should orthopedic surgeons consider reducing the negative effects of Outerbridge grade 2 patellofemoral chondral lesion on early postoperative recovery during anterior cruciate ligament reconstruction

  • Hakan SofuEmail author
  • Yalkin Camurcu
  • Ahmet Issin
  • Hanifi Ucpunar
  • Seckin Ozcan
  • Serda Duman
Original Article • KNEE - ARTHROPLASTY



The purpose of this study was to comparatively evaluate the effectiveness of intra-articular PRP and HA injections applied as the treatment of Outerbridge grade 2 chondral lesions in patellofemoral joint during arthroscopic ACL reconstruction.


The clinical and radiographic data of 61 patients between 18 and 45 years of age were evaluated. The patients were separated into three groups. Hyaluronic acid injection was applied in 22 knees (Group 1), PRP injection was applied in 18 knees (Group 2), and 21 knees did not have any specific treatment except ACL reconstruction (Group 3). All patients were followed clinically at least for 12 months. Clinical examination of the operated knee, visual analogue scale (VAS) score, Lysholm knee score, and Tegner activity scale were the outcome measures. Routine X-ray and MRI were also performed for all patients at 12-month postoperative follow-up visit.


Although the mean VAS and Lysholm scores at 3-month follow-up were better in Group 1 and 2 than Group 3, the efficacy of intra-articular PRP on healing process regarding progression of the mean VAS and Lysholm scores through 6- and 12-month follow-ups was significantly better and longer than HA. No statistically significant differences were detected according to Tegner activity scale between the groups at 3 and 6 months; however, Group 2 had better activity level than both Group 1 (p < 0.001) and 3 (p < 0.001) at the end of 12 months after surgery.


Intra-articular PRP injection applied as the treatment of concomitant Outerbridge grade 2 chondral lesion in patellofemoral joint during ACL reconstruction revealed better and durable clinical outcomes via decreasing the potentially negative effects of chondral pathology on postoperative healing with respect to HA injection.

Level of evidence

III—retrospective comparative study.


Anterior cruciate ligament Cartilage Patellofemoral joint 



This study has been approved by the institutional review board.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Hakan Sofu
    • 1
    Email author
  • Yalkin Camurcu
    • 2
  • Ahmet Issin
    • 2
  • Hanifi Ucpunar
    • 2
  • Seckin Ozcan
    • 2
  • Serda Duman
    • 3
  1. 1.Department of Orthopedics and Traumatology, Bahcelievler Medicalpark HospitalIstinye UniversityIstanbulTurkey
  2. 2.Erzincan University Faculty of MedicineErzincanTurkey
  3. 3.Diyarbakir Selahaddin Eyyubi State HospitalDiyarbakirTurkey

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